EXPERT OPINION Dr. Durick, who understands what it takes to run a successful facility, practices what he preaches at Fremont (Calif.) Surgery Center.

I'm a practicing anesthesiologist and former medical director of a bustling surgery center, so I know what makes anesthesia providers tick and what it takes to tap into their full potential as clinicians and team players. Here's what you can do to help ensure your providers deliver cost-effective, efficient and safe patient care, while also contributing to your facility's overall success.

1Value their contributions
Have you given your anesthesia providers everything they need, within reason, to do their jobs safely and quickly? If you've held off from buying the video laryngoscopes they've requested, you could have unintentionally created animosity amongst the team, giving the impression that their jobs aren't valued enough to purchase a tool proven to help us deliver safe care. It's also a misconception that providers don't generate revenue for your facility. Take regional blocks, for example. Depending on the payer, you can bill for the technical part of the block and collect facility fees.

2Eliminate downtime
Providers don't get paid unless they've got a needle in a patient or they're in the OR delivering anesthesia. They want to run efficient cases, maximize their time in your facility, bill for as many cases as possible and head home at a reasonable hour. The best way to incentivize providers to move cases along at a safe and efficient pace is to show them that you're actively trying to run an efficient center and will do everything in your power to minimize their downtime. Sharing specific examples will get them onboard with your efforts. If you move up a cataract case from 3:30 p.m. to 1:30 to fill a gap in the schedule, let your providers know so they're aware of your attempt to streamline the day.

The biggest piece of the efficiency puzzle is setting a realistic and accurate surgical schedule. That job is made easier with software that lets you conduct real-time case tracking. The software used at my last facility continually updated the average time it took for specific surgeons to perform specific procedures. When a surgeon booked a routine knee scope, for example, we knew to the minute how long it would likely take him to complete it. That powerful information let us block out efficient surgical schedules based on accurate case times, and kept our surgical team and anesthesia providers busy throughout the day.

3Set expectations
Surgeons have to show up on time — we'll save the discussion of whether that actually happens for another article — so demand the same from your anesthesia providers. We're sometimes guilty of being a little too cavalier with having the patient ready as soon as surgeons walk in the door.

Some anesthesia providers can improve their infection control practices, especially when it comes to hand hygiene. Yes, we anesthesia providers don't always disinfect our hands after airway manipulation, wear gloves to start an IV or clean the anesthesia workstation between cases. That requires education, monitoring and clear communication of your expectations. Have frank conversations with your providers: We're shooting for a zero SSI infection rate. We strictly enforce our infection prevention policies, which are a condition of working here.

4Demand excellence
Your anesthesia team should constantly explore ways to enhance patient care and clinical efficiencies by using a light anesthesia touch, effective pain control methods and PONV prevention protocols. The unprecedented amount of consolidation among anesthesia provider groups over the last decade — the large national group I'm working for has been bought up by an even larger group — could limit competition in your market and leave you with few options if you're unhappy with the performance of your current team. However, provider conglomerates are typically staffed with professionals who realize delivering quality care will improve outcomes and drive down the overall cost of health care. In fact, the company I work for requires me to complete a form that tracks 40 elements related to quality measures — including potential issues, from a simple anesthesia delay to death — before billing for a case.

5Expect more
Nameless, faceless, masked providers who consider themselves nothing more than plunger pushers have no spot on my anesthesia team. The value an anesthesia group brings to the head of the table must go beyond providing average anesthesia and leading the occasional staff in-service on how to improve IV starts. Groups that excel employ providers who bring value that you might not have even considered and have administrative expertise that extends beyond running anesthesia departments. They might have experience running their own facilities or surgical departments; understand the billing side of surgery and have expertise in contracting; or know how to manage medication stocks and work with supply chain management. Ultimately, they understand the challenges of running a lean, mean surgical facility, take ownership in optimizing patient care and constantly strive to exceed your expectations.

First the carrot, then the stick
If you're frustrated with the performance of your anesthesia team, sit them down and ask how you can collaborate to improve the situation. Your providers will likely provide insightful ideas, and tapping into their expertise would give them ownership in the process improvements you decide to enact. If your anesthesia team still can't contribute to the safe and efficient care that's necessary in the outpatient setting, it might be time to bring in different providers who can and will. OSM